Speaking to the needs of women in counseling

Rosemarie Scotti Hughes, dean emerita of the School of Psychology and Counseling at Regent University in Virginia, believes that counselor education needs to update the curriculum on the developmental cycle of women and family structure as currently taught in entry-level counseling courses. People are far more diverse in their lifestyle choices than in decades past, she says, but the curriculum hasn’t kept pace.

American women today are getting married and having children much later, on average, than did previous generations. Others are choosing to remain single or raise children on their own or with an unmarried partner. For the first time ever, single adult women outnumber married adult women in the United States.

“The traditional teaching we used to do about life cycles in Counseling 101 or 102 isn’t happening anymore,” Hughes says. “We need to present to students ‘this is what families look like now.’ We need to present a variety of models of what a family can be: same-sex couples, [young adults] living at home after graduating college, couples living together sometimes long years before getting married, having children from multiple partners … single moms who have no intention of marrying.”

Regardless of her life choices, today’s woman is not living in the same world that her mother and grandmothers lived in. In 1960, the median age for a first marriage was 20.3 for women and 22.8 for men in the United States. In 2016, the medians were 27.4 for women and 29.5 for men — roughly a seven-year difference for both genders. In addition, according to the U.S. Centers for Disease Control and Prevention, in recent years, the overall birthrate for American women in their 20s has decreased slightly, whereas the birthrate for women in their 30s has increased.

The social and cultural shifts that Hughes acknowledges are, to use an appropriate pun, married to the issues that female clients bring into the counseling office, from relationships
and family dynamics to career planning and parenting.

These shifts have brought progress in many ways. More and more women are attending college and joining the workforce. At the same time, women continue to struggle with challenges that have plagued the generations before them, such as balancing career and home life and struggling for professional advancement in male-dominated atmospheres.

This reality raises two interrelated questions: What do today’s women need from professional counseling? And how can today’s counselors strive to hit this ever-moving target?

Diving in

A first step is getting to know the context, culture and full story of the client who is sitting in front of the counselor. Most likely, her experience won’t mirror exactly the U.S. averages for marriage, childbirth, education and other issues.

Recent statistical shifts also differ greatly for women from different backgrounds, especially women of color, notes aretha marbley, an American Counseling Association member and professor of counselor education at Texas Tech University. Women shouldn’t be lumped into one monolithic group, she says, pointing out that the label includes those who are economically disadvantaged, disabled, transgender or otherwise marginalized.

“We need to do a better job of having the voices of all women heard and not just [middle-class female] voices. We’re probably better at that than men, but we’re still not good,” marbley says. “Especially in counseling, don’t make assumptions. Don’t let our voices overshadow those who are marginalized. We really, as counselors, need to do a better job and check our biases at the door — because they’re there.”

Lisa Forbes, an assistant clinical professor in the counseling program at the University of Colorado Denver who also works with clients at an inpatient psychiatric unit at a nearby medical facility, agrees that it is important that counselors not make assumptions. “You can read all the literature on this topic and know everything about women’s rights and equality, but it might not be that way for the woman who is in the room with you. Take each client as their own person,” says Forbes, an ACA member. “First and foremost, take a look at your own beliefs and your own values of stereotypical gender roles. If you’re not constantly trying to challenge those things, you will bring it into the room. … Don’t make assumptions, across the board. Just like any form of multicultural counseling, know the literature, know your personal biases, but get to know your client for who they are and what they need.”

Supporting women clients

Forbes co-presented a session titled “Identity Development of Working Mothers: How to Support Their Mental Health Needs” at ACA’s 2017 Conference & Expo in San Francisco with Margaret Lamar, an assistant professor in the counseling program at Palo Alto University. Women’s issues, especially in the realm of working mothers, is a professional and personal area of interest for Forbes and Lamar, both of who work full time while raising children.

Women frequently can find themselves bumping up against a lose-lose situation, Lamar says. She explains that a woman who works often gets judged as being a bad mother because she doesn’t see her children as much as stay-at-home moms see their kids. At the same time, her workplace supervisors or co-workers might feel she is a liability because she still has to manage the pull of children and family distractions. Pew Research Center data indicate that mothers now spend more hours per week engaged in child care than women did in 1965, Lamar notes.

“There is an expectation that moms should be more present as mothers, but at the same time we’re seeing more and more women in the workforce,” says Lamar, a licensed professional counselor (LPC) and ACA member. “We see women having more anxiety, more depression and feeling overwhelmed. When women are trying to juggle all of these things, the first thing to go is self-care and a focus on relationships. They go into survival mode.”

“These are things that are showing up in our counseling sessions,” she continues, “and we need to be mindful of the language we’re using [and] how we’re pathologizing women. Be aware of that oppressive social context so we are not blaming women. Talk with your clients about [how] they are living in a climate where these expectations are commonplace and it affects mental health.”

Hughes, a recently retired LPC and licensed marriage and family therapist (LMFT) in Virginia, says she often saw female clients who had children later in life and struggled with perfectionism. They often kept their children involved in an endless string of activities, from dance classes and sports to music lessons and Scouts, and then planned extravagant birthday parties and other social activities, Hughes observes.

“They’re adding so much stress to their lives, all of this on top of working,” says Hughes, who wrote the chapter on feminist theory in the ACA Encyclopedia of Counseling. “They keep the kids involved in so many things because they think the kids need all these things for them to be a good mother. I don’t see that they can accept the concept of being a ‘good enough’ mother. … Thinking they can put all of these things into a 24-hour day is fairly unrealistic. You can work and raise your family, but you can’t be supermom. We were never meant to be supermom.”

Hughes says counselors can work with these clients to challenge the irrational thinking that spurs perfectionism and help them focus on what matters most: their relationship with their children.

This “intensive mothering expectation” can lead to self-esteem and identity issues, anxiety, depression and other mental health struggles, Forbes says. The concept, coined in the mid-1990s in the book The Cultural Contradictions of Motherhood by Sharon Hays, an assistant professor of sociology and women’s studies at the University of Virginia, originates with the stereotypical ideal of the 1950s housewife: The woman keeps the household running while bearing responsibility for the majority of household chores and child-rearing tasks.

Decades later, that expectation — whether stated overtly or in more subtle ways — is still going strong, Forbes says. “It puts women in a tough spot, and that’s all wrapped up in our identity development. It’s the idea of a mom who is always involved, takes the kids to their activities and makes kale smoothies every day — being everything for everyone — and it’s really an impossible feat. That’s kind of what we judge women by, and I think it’s unfortunate that we can’t bend a little bit on that.”

Women can even project these expectations onto other women, intentionally or unintentionally, through social media posts and in-person comments, further perpetuating the problem. Forbes has seen this play out in her own life. She is the mother to a 4-year-old and a 2-year-old, and her husband travels often for work.

“I personally struggle a lot with balancing all of these roles and the expectations that moms are put under,” she says. “If I spend an hour away from my kids, I am judged, but if my partner spends an extra hour with the kids, he is patted on the back.”

“If we [practitioners] don’t challenge our own beliefs on this, we will inadvertently bring this into the counseling session,” she adds.

The importance of language

Most of all, counselors must be mindful of the language they use with female clients and check their own assumptions, Lamar says. For example, a counselor working with a female client who is feeling anxious and overwhelmed may initially assume that the woman simply needs to take on less, delegate responsibilities to a partner or ask for help. Although well-meaning, these suggestions carry the implication that the woman is responsible for everything and should be the one to give the responsibility away, Lamar says.

Instead, the counselor might coach the client to negotiate responsibilities with a partner and make a plan, from arranging for childcare to doing the grocery shopping. “It’s really a … shift in our thinking of how to approach that [with a client]. It needs to be both partners coming at this together and negotiating on equal footing,” Lamar says. “It may not be as simple as having trouble setting boundaries. She is under pressure to take on all these pieces in order to feel like she’s a good mom or a good employee. Pay attention to how we acknowledge that instead of placing the responsibility on the woman.”

Similarly, a counselor working with a new mother who is getting ready to return to work should think twice about asking her whether she is ready or if she can handle it, Forbes says. Those kinds of questions assume that it is all up to her. The underlying message is, “You’re the mom. You should stay home,” Forbes observes. Likewise, questions such as, “How are you going to balance everything?” send the message that the client has to balance everything, she
adds. Instead, Forbes suggests that counselors turn their questions to focus on how the mother can advocate for herself to find support and equality at home and at work.

Cassie Owens, an LPC in private practice in Dunwoody, Georgia, cautions that counselors shouldn’t lump their female clients into specific categories — new mother, working professional, single mother — and make related assumptions. “There’s so many different chapters to a woman’s life, and most women wear more than one hat. Be really mindful when asking questions and doing assessments, and don’t make assumptions … based on that first, initial impression or intake session,” says Owens, who specializes in maternal mental health and works exclusively with female clients.

Forbes also focuses on the importance of getting to know the client and her situation. “Listen to a client’s language. Is she wanting help, or is she not sure how to ask? … What changes in her life does she want to make, and what can she advocate for?” counsels Forbes. “Always check in to brainstorm ideas. … Have them make a list and pick one [area to focus on]. What’s the worst-case scenario of an outcome, and what’s the best-case scenario? She knows better than you how things might turn out.”

The same wisdom applies when counseling clients about issues in the workplace, Lamar says. A counselor should not coach a female client to speak up when she is being overlooked professionally without considering her circumstances and professional context. “You should stand up for yourself” is often impractical advice for a number of reasons, including the risk of repercussions, Lamar explains.

“People still underestimate the pressures that women feel in the workplace. I work in academia and mental health, two [professions] that are supposed to be more ‘aware,’ and I have had people take credit for ideas that I’ve had or talk over me in meetings,” Lamar says. “I had a male student explain to me why some [of my] research was wrong. It kind of baffles me. There’s just so many women who experience these kinds of things — microaggressions, victim blaming and, recently, sexual harassment. These are things that women experience all the time to varying degrees.”

The widespread nature of these experiences has made headlines recently as more women have begun coming forward to report cases of sexual harassment involving major figures in
the worlds of politics, entertainment, news media and other professions. We have also repeatedly witnessed examples of why women often choose not to report wrongdoing out of a fear of making waves and the victim blaming that can follow.

Identity and resetting the narrative

It may be useful for counselors to weigh protective factors in female clients’ lives against their risk factors, Forbes says. For instance, counselors might look for areas of life where these clients can strengthen their network of support socially, professionally or therapeutically, such as through local women’s or mothers’ groups, social clubs, nonprofit organizations or church groups.

Finding a “tribe” of people a client can relate to is helpful in combating the feelings of isolation that often accompany many of the issues with which women struggle, especially postpartum depression, Owens says. Online groups can also be a source of support for new mothers or women in different stages of life, says Owens, the vice president of the Georgia chapter of Postpartum Support International. Owens had one client who was a member of a Facebook group for local moms. She invited others to join her for a walk, posting the date, time and location of where to meet. Several women came, allowing her to meet some new people with the shared experience of motherhood.

“That takes a lot of courage, but she really wanted to meet people in her neighborhood,” Owens says. “Also know of support groups that other therapists are running, and know and work with other practitioners in your area. A counselor can help a client navigate them and just [let them] know that these kinds of things exist.”

Counselors can also help support female clients by exploring issues of identity. Often, a woman’s identity is tied to expectations that she has internalized, Forbes says. Counselors can help clients dismantle unhealthy expectations — for example, the mother who does it all — and become aware of how unrealistic they are.

Identity can also be central for women facing transitions, such as a client having a baby in her late 30s after a decade of building a career. This can be a “shock to the system,” Forbes says, because it upsets the equilibrium the client previously felt in her identity.

“Talk the client through her new identity. Being a mother is such a strong identity for a woman, but how can we add that to your existing identity [rather than replacing it]?”asks Forbes. The counselor needs to meet the client where she is. Instead of saying, “This will change everything,” help her to make a plan and rely on a support system, Forbes says.

Owens agrees. “If they’ve had a career and decide to stay home with a baby, it’s a huge change in identity, a loss of self and [can be] a loss of self-worth. Or, it’s the juggling act of going back to work and balancing life. ‘How am I going to be a good mother and employee and [still] take care of myself?’”

In addition to focusing on protective factors, Forbes finds that narrative, feminist and relational-cultural therapies are often helpful when working with female clients. Bibliotherapy can also be used to normalize the expectations and pressures that female clients may be feeling. Forbes recommends anthropologist Solveig Brown’s book All on One Plate: Cultural Expectations on American Mothers to learn more about the intensive mothering concept and its unrealistic expectations.

Helping clients recognize the unrealistic expectations that society often places on women is important, regardless of the theory or method a counselor uses. “There’s so much value in externalizing the problem from the woman. Patterns can be so ingrained that you don’t challenge them, but if you can name them and externalize them, it can be liberating,” Forbes says. “It’s really empowering for women to get to that place that ‘I am not my symptoms; my symptoms are the result of my experience.’”

For example, a female client may be struggling with the decision to take a promotion at work because she feels her children need her more. “Go deeper. Ask the client, ‘What does that mean for you when you have that thought?’ Is it about guilt? If she feels she should be at home with her children, that guilt could turn into low self-worth and feelings of ‘I’m not a good mom,’” Forbes says.

“I would externalize that guilt that she has,” Forbes continues. “She feels like it’s her fault that she has two different roles — mother and employee — and that guilt comes from within. Talk about where that guilt [actually] comes from: greater society. Challenging those societal expectations can help.”

Similarly, Forbes suggests, feelings can be externalized through a version of the empty chair technique typically associated with Gestalt therapy. The client is invited to put her guilt in an empty chair so that she can visualize it, feel it and talk to it. That takes the blame away from the client and helps her realize that “this is not you; it’s your experience of expectations and unfair stereotypes,” Forbes explains.

“Tell [the client], ‘You are not a failure. You live within a context of a culture, within a family, and all of those things affect your self-image and your mental health,’” she says. “They can rewrite their own story on how it works for them, not the way they’ve been told it should be.”

The long road to progress

Although cultural shifts mean that more women are advancing in their careers and living independently, the struggle for progress is far from over. The counselors interviewed for this article agreed that the conversation needs to be ongoing.

Women still shoulder the burden of unpaid maternity leave, child care costs that can be staggering and a pervasive wage gap between them and their male counterparts that is even more pronounced for women of color. There is substantial potential, Lamar notes, for counselors to strengthen their role as client advocates, especially when it comes to policy changes surrounding family leave, child care and other social issues.

“We’re not in a place, as a group of women, to say we’re all done [making progress] now,” says marbley, an LPC supervisor and leader of the ACA Women’s Interest Network. “We need to continue to advocate for those who don’t have the power or ability to do so. We’re not free yet. We’re not ready to say it’s all equal. We can still do better, and if we [women] empower each other, we can help. At the end of the day, it’s not bad. We just have more work to do.”

Hughes was the first female academic dean at Regent before she retired from counselor education in 2009. She notes that throughout her tenure, most of her colleagues and subordinates were male. Likewise, marbley says that in her experience, promotion and tenure remain a struggle for women in counselor education. She also notes that many of the conferences and professional events that young women counselors attend are led by males.

Counseling is a relatively young profession. Perhaps, Hughes says, the work of recognizing the subtleties and needs of women in counseling can be attributed to the profession’s growing pains. “This is all part of counseling’s struggle with identity,” she says. “I’m still not sure if counselors know who we are.”

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Statistics snapshot: Women in America

On average, women make 80 cents for every dollar earned by a man, a gender wage gap of 20 percent (full-time, year-round employees, as of 2015).

Women who are single or living with a nonmarital partner account for 4 out of 10 U.S. births. Less than half of children (46 percent) are living in what has previously been considered a “traditional” household: a family with two married parents in their first marriage.

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YES YES YES!!! This article is so right on! For us “senior” age therapists, we need to understand all the changes and shifts for women in our culture. Their world is so much different than our training and what seems “normal to us.” There are so many new normals now! Included in the mix is the fact that over half of these women may have chosen voluntary pregnancy termination. We are doing women a disservice not being informed as therapists on how to help them grieve this hidden loss. Thanks for the great article with supporting statistics!